Randomised Controlled Trial of Pre-Procedure Virtual Bronchoscopy Planning Compared To Conventional Computed Tomographic Planning For Endobronchial Ultrasound Guide Sheath Procedures

INTERVENTION: The iLogic inReach (superDimension) software creates a virtual bronchoscopic map as well as a three dimensional external map of the bronchial tree from information obtained from CT scan data. It also provides simultaneous review of CT scan images in three different planes (coronal, axial, sagittal). The bronchoscopist will use this software to map a pathway to the target lesion and will then review the intended pathway by virtual bronchoscopy. This planning method will take 5‐30 minutes. The EBUS GS system consists of a radial ultrasound probe which is inserted into a flexible guide sheath in the working channel of the bronchoscope. Ultrasound images help the bronchoscopist determine the density of the tissue which the radial probe is passing through. Normal lung produces a "snow storm" appearance whereas mass lesions show a well defined border which represents the change in density between normal aerated lung and the solid mass. The radial ultrasound probe is then removed and the pre‐measured biopsy forceps and cytology brushes are then pass through the guide sheath to sample the target lesion. CONDITION: Peripheral pulmonary lesions PRIMARY OUTCOME: Complication rate (pneumothorax, unplanned hospital admission, major and minor bleeding) Diagnostic yield ; Once the target lesion is localised using EBUS a minimum of 6 transbronchial biopsies, cytology brush samples and 5‐10ml miniBAL will be taken for microbiology/culture/sensitivity, cytology and histology. Diagnostic yield will be calculated as : ; number of procedures which provide a diagnosis / total number of procedures. ; ; In cases where EBUS GS directed biopsies does not provide a diagnosis, the patient will be followed up for 12 months to determine whether other subsequent diagnostic modalities provide a histological diagnosis. Procedure Time SECONDARY OUTCOME: Localisation of lesion on EBUS GS INCLUSION CRITERIA: Age 18‐85 Patients with a peripheral pulmonary nodule undergoing EBUS GS directed biopsy for diagnosis